Malaria remains a major cause of morbidity and mortality world-wide. World-wide more than 100 countries are endemic, but mainly in African and south East Asian region. We report a case of an uncommon presentation of Plasmodium falciparum infection in a 50-year-old male patient who presented with hyperglycemia and multiple organ dysfunction syndrome. Reports of unusual presentations of malaria are few and cases of severe malaria with hyperglycemia are rarely described. As hyperglycemia is associated to most severe malaria and high mortality, our aim is to draw the attention of the physicians on this entity.

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Introduction: Health care financing is the mobilization of funds for health care services. This study determined the various sources of health care financing among the patients on admission at the Ahmadu Bello University Teaching Hospital (ABUTH), Shika-Zaria in 2011 and the effects of the medical bills on the patients and their family members. Methodology: A multi-staged sampling technique was used to select 100 clients for the study. The clients were stratified into the four major wards of the ABUTH; the medical, surgical, obstetrical and gynecological and the pediatric wards. A total of 25 clients were equally allocated to each ward and these were then selected by balloting. Information was sought on their socio-demographic characteristics, sources of the health care financing and the adverse effects of the medical bills on the patients and their family members. Results: Majority of the clients were married, Hausa Muslim housewives who earned < N5,000/month (less 1 $/day). Most were aged between 20 and 29 (34%) with a mean age of 36.7 years. Patients' relatives paid for the medical bill in most of the cases (48%), 37% paid through out of pocket, while 11% used the National Health Insurance Scheme (NHIS) respectively. The medical expenses affected family feeding (29.3%), while 16% of the patients could not get full medical services due to lack of funds, 8.8% could not pay school fees of their children and 12.2% were indebted. There were no significant association between the age, sex, marital status, monthly income, occupational status and the clients' sources of health care financing. Majority of the clients (65%) were not aware of the NHIS. Most (80%) of the patients would want to use the health insurance scheme (NHIS) if they have access to the opportunity. Conclusions: The main source of health care financing in this tertiary center was through out of pocket expenditure by patients and their relatives. Recommendation: There is a need for the urgent implementation of the community health insurance scheme in Nigeria for the benefit of the less privileged.

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Grave's disease account for about 85% of hyperthyroidism during pregnancy. If not properly managed, it can result in severe maternal, fetal and neonatal morbidity and mortality. Anti-thyroid drugs are the main treatment for Grave's disease during pregnancy. The lowest possible dose should be used to maintain maternal free thyroxine levels at or just above the upper limit of the normal non-pregnant normal range. Fetal thyroid function depends on the balance between the trans-placental passage of thyroid-stimulating maternal antibodies and thyroid-inhibiting anti-thyroid drugs. In developing countries where propylthiouracil is either expensive or not available the use of carbimazole at lower doses is safe. Two cases are here presented to buttress this view.

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Background: Humans and animals are exposed to sodium nitrate through the air, food and drinking water. Because nitrates induce oxidative stress, the effects of antioxidant vitamins ascorbic acid and α-tocopherol on oxidative damage induced by sodium nitrate on reproductive organs of male Wistar rats were studied. Methodology: Five rats each in four groups were treated for 60 days. They received distilled water (Group I), 3 mg/100 g body weight NaNO ₃ (Group II), 3 mg/100 g body weight NaNO ₃ + 50 mg/100 g body weight ascorbic acid (Group III) and 3 mg/100 g body weight NaNO ₃ + 30 mg/100 g body weight α-tocopherol (Group IV). Live weights of the animals were obtained at the beginning of the experiment and every 2 weeks subsequently. At the end of the study, the left testis, epididymis and seminal vesicle of each rat was carefully removed and weighed. These organs were also examined for histopathological lesions. Results: Testis:body weight ratio and seminal vesicle:body weight ratio of Group II animals were less than (P < 0.05) those of the control. Epididymis:body weight and seminal vesicle:body weight ratios of Group III animals were significantly lower than those of Group II. Testis:body weight ratio of Group IV animals was significantly less than that of Group II. There was testicular degeneration with absence of spermatids and spermatogenic cells in the semeniferous tubules and absence of epididymal sperm reserve in Group IV animals. Conclusions: The results indicate that intake of ascorbic acid and α-tocopherol may enhance oxidative damage in the testis, epididymis and seminal vesicle during chronic sodium nitrate exposure.

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Ethambutol is a widely used first line agent against tuberculosis, which still remains a disease of significant morbidity and mortality in the developing world. We hereby present a rare case of ethambutol induced acute blindness. Even though, it is a rare incidence of severe form of toxicity of this widely used drug the possible consequences can be alarming for the medical fraternity who is rampantly using this drug.

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Introduction: Malaria remains the highest cause of morbidity and mortality in sub-Saharan Africa. Early diagnosis is therefore essential for treatment and management of the disease. The objective of this study is to determine malaria prevalence in some children in Kano Metropolis using rapid diagnostic test (RDT). Methodology: 210 households were administered with a structured questionnaire and blood samples were collected from 85 children, while 125 children were non compliance. For each of these children, rapid diagnostic test (RDT) kit {Smart Check Malaria P.f cassette (Globalemed, 1101 King St. Suite 370, Alexandria, VA 22314 USA)} was used, using blood obtained from a finger prick. Result: Blood sample obtained from 85 children showed that 26 (30.59%) were positive and 59 (69.41%) were negative. The age of the children range from 1-5 years and there were 40 males (38.46%) 45 females (61.54%). The prevalence of malaria is high among the respondents. Conclusion: The majority of the respondents sought treatment from health facilities. However, few children got treatment from chemist and at home or did not get treatment for malaria. Children should be advised to seek treatment whenever they have malaria from health facility. This is to ensure that the treatment given is appropriate.

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Carotid body tumor (CBT) is a Paraganglioma arising from the chief cells of the carotid body, which is situated at the bifurcation of the common carotid artery. We describe the fine needle aspiration cytology findings of one such tumor in a 45-year-old man. The aspirate was hemorrhagic with clusters of round to oval cells showing moderate  anisokaryosis [anisokaryosis is found to be used in standard textbook of cytology (like Orell, Gray, Bibo, Chiba's text book of cytology) to indicate the varion in size of the nucleus. In hematology 'anisocytosis' is used to indicate the variation in red cell size]. Delicate fibrous strands with spindle cells were observed within these clusters. Based on these cytologic findings and the location of the swelling, a diagnosis of CBT was made. The mass was excised and the diagnosis was confirmed on histopathological examination. Our case report adds to the existing literature on cytologic diagnosis of CBT, further attesting to its safety and accuracy.

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Background: Children and toddlers are highest risks of falling prey to malnutrition. Locally indeginous calorie and protein rich supervised supplementation is a promising endeavour towards childhood growth emancipation. Objective: To assess the impact of nutritional rehabilitation using energy dense local food as Ready to Use Therapeutic Food (RUTF) among malnourished hospitalised children. Methodology: One hundred and twenty five hospitalised malnourished children (Grade III and IV PEM, Protein Energy Malnutrition (as per the Indian Academy of Pediatrics, IAP guidelines) in the age group 6-60 months were included in the study. Their prevalent feeding practices were recorded. They were divided into three groups - Group A (given Family diet only), Group B (given Family diet + RUTF) and Group C (given Family diet + RUTF + Multivitamin preparation containing zincovit drops 5 drops per serving). Their weight, height, Mid Upper Arm Circumference (MUAC), haemoglobin levels and Serum albumin were monitored for 2 months. Results: Lack of early initiation of breastfeeding (66%), giving prelacteal feeds (61.0%), lack of exclusive breastfeeding (83.4%) and non initiation of complementary feeding at 6 months (60%) are the prevalent IYCF practices. Nutritional rehabilitation with Family diet alone (Group A) was less effective in contrast with family diet + RUTF (Group B) and Family diet + RUTF + Multivitamin (Group C). Addition of multivitamin (Group C) to RUTF (Group B) failed to exhibit added nutritional benefits. Conclusion: Prevalent IYCF practices were far from optimum compared with the recommended guidelines. RUTF from the locally available foods is cheap and effective in combating malnutrition effectively. Addition of multivitamins showed no benefit. RUTF prepared from locally available food for nutrirional rehabilitation malnourished children is recommended.

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Background: Fineneedle aspiration cytology (FNAC) as a cheap diagnostic technique has helped reduce diagnostic turnaround time of pathological entities from different body sites. It is thus also important to evaluate its utility in the diagnosis of maxillofacial lesions in view of heterogeneity of morphological patterns noted for this site. Methodology: Cytology and corresponding histology reports for lesions from patients where both were available were compared for concordance between specific cytological diagnosis and final histological diagnosis. From these, sensitivity, specificity, positive predictive value and accuracy of FNAC were calculated. Result: Cytological diagnosis of maxillofacial lesions demonstrated a sensitivity, specificity, positive predictive value and accuracy of 100%, 95.7%, 97% and 98.2%, respectively. The concordance of specific cytological diagnosis with final histological diagnosis was 85.5%. Conclusion: This study concludes that FNAC is a cheap and diagnostically reliable technique for evaluation of maxillofacial lesions in a resource poor setting.

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Background: Breast cancer is a leading cause of death among Nigerian women. Patients typically present late with advanced and aggressive diseases from a younger age. Cure for breast cancer is only possible when the disease is discovered early and breast cancer screening greatly increases the chances of early detection. We present the results of a breast cancer screening program at the Taimako Breast and Cervical Cancer Screening Centre, Lafia, Nigeria. Methodology: This is a prospective study of subjects who presented to our breast cancer screening centre between May 2009 and April 2010. A community mobilization and awareness campaign was mounted 3 months before screening began. A structured questionnaire was administered on each subject to elicit demographic data and risk factors. Each had a clinical breast examination. Those 35 years and above had a mammography while those below 35 years had breast ultrasound scan. Where a lump was discovered, it was subjected to tissue biopsy and histology. Results: Two thousand and ninety five subjects were seen over the one year period. Mean age was 34 + 12 years. Mean age at menarche was at 14.3 + 1.7 years, mean parity was 3.6 +2.6. Two thousand and thirty six subjects (97.2%) had some knowledge about breast cancer, 1,269 (60.5%) had no formal education, 881(42.1%) were petty traders while 501(23.9%) were full time housewives. Four hundred and seventy (22.4%) had a positive family history of breast disease, 437 (20.9%) had history of use of oral contraceptives, and 9 (0.4%) had a previous breast biopsy. Four hundred and sixty one (22.0%) complained of breast discomfort, 184 (8.8%) complained of breast lumps, but only 95 (4.6%) of them had lump on clinical breast examination, while a further 8 (0.4%) lumps were found on breast imaging. One thousand nine hundred (90.7%) had normal breast screening results, 166 (7.9%) had benign breast diseases and 29 (1.4%) had breast cancer. Conclusion: Knowledge about breast cancer was high because of prior campaigns and should be encouraged. Proportion of subjects with breast cancer is low even though many complained of breast lumps on presentation. Majority of the lumps were found at clinical breast examination while mammogram had a very low yield. A treatment arm needs to be incorporated into the screening program to demonstrate survival benefit.

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Background: Gastrointestinal (GI) complications can retard or limit a patient's rehabilitation and functional recovery. Thus, if not recognized and prevented early, they can be a significant determinant of morbidity and mortality in patients with stroke. Objective: The study was designed to determine the frequencies of GI symptoms in stroke survivors and to evaluate their relationships with functional performance. Methodology: Consecutive patients with diagnosis of stroke in medical wards and neurology clinic at the Aminu Kano Teaching Hospital and apparently healthy age and sex matched volunteers were recruited. A structured, pre-tested, close-ended questionnaire inquiring about common GI symptoms and demographic and stroke characteristics such as type, number and hemispheric side of stroke was administered in each case and control. Functional performance was assessed using the Barthel index. Results: A total of 150 patients and 150 control subjects were recruited for the study. The mean age of the patients was 58.1 ± 13 and that of the control subjects was 58.0 ± 12 and the difference was not statistically significant (P = 0.9846). There were 113 (80.7%) ischemic stroke and 27 (19.3%) hemorrhagic stroke. The most common GI symptoms were constipation (16.7%), dysphagia (12.1%) and masticatory difficulty (10.0%). There was no statistically significant difference in the occurrence of GI symptoms with respect to side of stroke. Constipation, dysphagia, masticatory difficulty, incomplete evacuation, abdominal pain, malnutrition, vomiting, bloating were found to be associated with low functional performance. Conclusion: Constipation, dysphagia and masticatory difficulty were the most common GI complications. They appear to be independent of the side or type of stroke, but are associated with low functional performance of the stroke survivors.

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Ovarian ectopic pregnancy is an uncommon presentation of ectopic gestation, where the gestational sac is implanted within the ovary. Primary ovarian ectopic pregnancy is random and chance occurrence with estimated frequency ranging from 1 in 2 100 to 1 in 7 000 pregnancies. The diagnosis is seldom made clinically, that is, before surgery. Early detection permits removal of the ectopic pregnancy without excessive removal of healthy ovarian tissue. A case of acute abdomen that certified Spiegelberg's criteria at laparotomy and histological confirmation of ovarian pregnancy has been presented.

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